Impact of differential glycemic management goals in pre-anhepatic and anhepatic phase on early grafted liver function after liver transplantation: An open-label, randomized, controlled study

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-03-15 DOI:10.1016/j.jclinane.2025.111807

Yi Duan MD , Lei Cui MD , Zuozhi Li MD, PhD , Zhifeng Gao MD , Fulei Gu MD , Huan Zhang MD

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引用次数: 0

Abstract

Background

Liver graft function is related to the quality of liver transplantation (LT). High-quality perioperative glycemic management is considered hepatoprotective. However, no studies have explored the effects of specialized and staged blood glucose management target ranges on reducing glycemic variability (GV) and early allograft dysfunction (EAD) after LT.

Methods

In this prospective randomized controlled trial, a total of 188 LT recipients were randomly assigned 1:1 to the less intensive glucose management (LIGM) group and the more intensive glucose management (MIGM) group. They followed goals of 7.8–10.0 mmol/L and 4.5–6.7 mmol/L in the pre-anhepatic and anhepatic phases, respectively, and the goals of 4.1–10.0 mmol/L in the neohepatic phase and postoperatively. The primary outcome was EAD, and the secondary outcomes were GV, incidence of hyperglycemia/hypoglycemia, postoperative liver enzyme levels, 30-day postoperative infection rate, one-year survival rate, and TNF-α, IL-6 and C-reactive protein levels.

Results

A total of 182 adult patients (89 in the LIGM group and 93 in the MIGM group) completed the study. The mean age of the recipients was 51.46 ± 10.79 years, and the median MELD score before surgery was 16. The incidence of EAD was significantly lower in the LIGM group than in the MIGM group (10.11 % vs 31.18 %, P < 0.001), with a relative risk (RR) of 0.32 (2-sided 95 % CI 0.110–0.562). There was no statistical difference in the 30-day postoperative infection rate between the two groups (P > 0.05). The one-year survival rate of the LIGM group was higher than that of the MIGM group (92.13 % vs 82.02 %, P = 0.044).

Conclusions

Adopting LIGM (7.8–10.0 mmol/L) during the pre-anhepatic and anhepatic phases helps to reduce the incidence of EAD after LT and promotes the recovery of liver function, but does not increase the incidence of postoperative infections.

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背景肝移植功能与肝移植（LT）的质量有关。高质量的围手术期血糖管理被认为具有保肝作用。方法在这项前瞻性随机对照试验中，188 名肝移植受者被 1:1 随机分配到强化程度较低的血糖管理（LIGM）组和强化程度较高的血糖管理（MIGM）组。他们在肝前期和无肝期分别遵循 7.8-10.0 mmol/L 和 4.5-6.7 mmol/L 的目标，在新肝期和术后遵循 4.1-10.0 mmol/L 的目标。主要结果为 EAD，次要结果为 GV、高血糖/低血糖发生率、术后肝酶水平、术后 30 天感染率、一年生存率以及 TNF-α、IL-6 和 C 反应蛋白水平。受术者的平均年龄为（51.46 ± 10.79）岁，术前 MELD 评分的中位数为 16 分。LIGM 组的 EAD 发生率明显低于 MIGM 组（10.11 % vs 31.18 %，P < 0.001），相对风险 (RR) 为 0.32（双侧 95 % CI 0.110-0.562）。两组术后 30 天感染率无统计学差异（P > 0.05）。结论在肝前期和无肝期采用 LIGM（7.8-10.0 mmol/L）有助于降低 LT 后 EAD 的发生率，促进肝功能的恢复，但不会增加术后感染的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.